Carmen Lewis MD MPH is a candidate for the Cancer Prevention, Control and Population Sciences Career Development Award (K07). Her long-term career goal is to establish an independent research program to advance evidence based patient-centered care for adults in late life. Achieving the proposed career development objectives will ensure that the candidate has the skills necessary to be a successful independent researcher. The career development plan includes coursework to expand the candidate's research skills, tutorials to obtain content expertise in areas relevant to cancer screening in older adults, long-term research planning and mentored research. The rationale for the proposed research is that age appropriate colon cancer screening in adults age 75 and over is achieved with accurate physician estimates of patient longevity and patient centered decision making. Three aims are proposed. Specific Aim 1 is to understand primary care physicians'attitudes and decision making processes for colon cancer screening in older adults. It will be achieved with qualitative methods, specifically physician focus groups. For Specific Aim 2, a national survey of practicing physicians will be performed to determine physicians'abilities to make age appropriate screening recommendations in regards to three key elements: knowledge about the life expectancy needed to benefit from screening, uncertainty in estimating the benefit of screening from health states, and promotion of patient centered decision making. These results will inform Specific Aim 3, to develop and test the feasibility of a physician prompt combined with a decision support tool to promote age appropriate screening. The results from this study will be used to develop a multi-site randomized control trial of this intervention to determine its effect on colon cancer screening rates in healthy adults age 75 and over and the frequency of patient centered decision making. With this award Dr Lewis will be prepared to make significant contributions to cancer prevention and control in the aging U.S. population.